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NPI Code Detail

MEDICARE: MR. SEAN MICHAEL HENNESSEY LMSW

MEDICARE: MR. SEAN MICHAEL HENNESSEY LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
21041C0700XClinical Social Worker088250NY

General Provider Information

NPI Number : 1518235175
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SEAN MICHAEL HENNESSEY LMSW
Provider Business Mailing Address
First Line : 3911 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-5110
Country : US
Telephone Number : 718-948-3232
Fax Number : 718-966-6605
Provider Business Practice Location Address
First Line : 3911 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-5110
Country : US
Telephone Number : 718-948-3232
Fax Number : 718-966-6605
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2011
Last Update Date : 04/03/2014

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